Risk Factors for Delayed Initiation of Combination Antiretroviral Therapy in Rural North central Nigeria
Published Date:Feb 1 2014
Source:J Acquir Immune Defic Syndr. 65(2):e41-e49.
Antiretroviral Therapy, Highly Active
CD4 Lymphocyte Count
Health Services Research
Pubmed Central ID:PMC3818360
Funding:U2G PS001063/PS/NCHHSTP CDC HHS/United States
R24 TW007988/TW/FIC NIH HHS/United States
R01 HD075075/HD/NICHD NIH HHS/United States
R24TW007988/TW/FIC NIH HHS/United States
Timely initiation of combination antiretroviral therapy (ART) in eligible HIV-infected patients is associated with substantial reductions in mortality and morbidity. Nigeria has the second largest number of persons living with HIV/AIDS in the world. We examined patient characteristics, time to ART initiation, retention and mortality at five rural facilities in Kwara and Niger states of Nigeria.
We analyzed program-level cohort data for HIV-infected, ART-naïve clients (≥15 years) enrolled from June 2009-February 2011. We modeled the probability of ART initiation among clients meeting national ART eligibility criteria using logistic regression with splines.
We enrolled 1,948 ART-naïve adults/adolescents into care, of whom 1174 were ART eligible (62% female). Only 74% of eligible patients (n=869) initiated ART within 90 days post-enrollment. The median CD4+ count for eligible clients was 156 cells/μL [IQR: 81–257], with 67% in WHO stage III/IV disease. Adjusting for CD4+ count, WHO stage, functional status, hemoglobin, body mass index, sex, age, education, marital status, employment, clinic of attendance, and month of enrollment, we found that immunosuppression (CD4 350 vs. 200, odds ratio (OR)=2.10 [95%CI: 1.31, 3.35], functional status (bedridden vs. working, OR=4.17 [95%CI: 1.63–10.67]), clinic of attendance (Kuta hospital vs. referent: OR=5.70 [95%CI:2.99–10.89]), and date of enrollment (December 2010 vs. June 2009: OR=2.13 [95%CI:1.19–3.81]) were associated with delayed ART initiation.
Delayed initiation of ART was associated with higher CD4+ counts, lower functional status, clinic of attendance, and later dates of enrollment among ART-eligible clients. Our findings provide targets for quality improvement efforts that may help reduce attrition and improve ART uptake in similar settings.
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